Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
SHARED MEDICAL APPOINTMENTS Achieving Better Patient Outcomes and Organizational Efficiencies Part 1 of 2 Provided as an educational service by Pfizer Inc. NPC0149B1 © 2010 Pfizer Inc. All rights reserved. April 2010 1 Agenda • Why SMAs Are Timely • SMA Overview • Types of SMAs • SMA Effectiveness • Next Steps 2 Why SMAs Are Timely Today’s Practice Environment • The population is aging—the 65 years+ age group will increase by 78% by 2030 • Today’s patients bring in consumer ads or the Internet information • Increasingly complex medical treatments require more patient education Sources: He W et al. Current Population Reports. 2005:12; Noffsinger EB et al. Understanding Today’s Group-Visit Models:2. 3 Why SMAs Are Timely Today’s Practice Environment • Busy physicians are backlogged for appointments • Short appointments reduce communication time between physicians and patients • Patients experience dissatisfaction with appointment length or waits for appointments • Physicians may feel stressed and dissatisfied Source: Schmucker D. Group Medical Appointments. 2006:12-14. 4 SMA Overview What Are SMAs? • An SMA (group visit) is a periodic medical appointment held by a physician for 90 or more minutes to provide routine or follow-up care to groups of patients • The physician is supported by other health professionals in conducting the SMA • Private one-on-one time with the physician is available to patients who want/need it Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:4,9. 5 SMA Overview Characteristics of SMAs • SMAs are: – Voluntary and interactive – Care delivery systems (ie, not classes) – Designed to enlist patients in their own care – Efficient and effective Source: AAFP Web site. Group visits: introduction:2. 6 SMA Overview Patients Suited to SMAs • SMAs are well-suited to: – Patients with chronic conditions – High utilizers – Those with extensive emotional, informational, or psychosocial needs – Patients having difficulty making behavioral/ lifestyle changes—eg, smoking cessation, medication adherence • Source: AAFP Web site. Group visits: introduction:1; Schmucker D. Group Medical Appointments. 2006:85. 7 SMA Overview Privacy Issues • Anything patients say about themselves is not of concern regarding HIPAA –HIPAA requires written consent before providers disclose patients’ personal information • Patients sign privacy notice when entering meeting or exam room • Oral privacy reminders are given at the beginning of each SMA • Private time is available with the physician Sources: Schmucker D. Group Medical Appointments. 2006:147-148; SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:9. 8 SMA Overview SMA Benefits • SMAs offer: – – – – More time and a more relaxed pace of care Increased patient education Peer support and encouragement The opportunity to identify psychosocial issues or previously unnoticed medical issues – Care delivered by a team – Opportunity for family/caregivers to participate – Better customer focus Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:9,12. 9 SMA Benefits Patient-Centered Medical Home (PCMH) • PCMH: – Facilitates partnerships between patients and their physicians through a physician-led care team that takes responsibility for providing comprehensive, ongoing care – Emphasizes support for patient self-management – Focuses on improving patient access to care • SMAs are aligned with PCMH principles Sources: PCPCC Web site. Patient-centered medical home—from vision to reality:2; AAFP Web site. Patient-centered medical home checklist:2. 10 Types of SMAs Three SMA Models • Cooperative Health Care Clinic (CHCC) • Drop-in Group Medical Appointment (DIGMA) • SMA for Physical Exams (Physicals SMA) Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:122. 11 Types of SMAs CHCC • Target population: Chronically ill, high utilizers, same 15-20 patients every month, same day and time • It is co-led by the physician and his or her nurse • Patient benefits: – – – – Access to physician and nurse on regular basis Continuity of care Peer interaction Patient empowerment • Outcomes measures: – Office visits, hospital admissions, ER visits – Improved quality of life, self-efficacy, and activities of daily living – Patient and provider satisfaction • Variation: Disease-specific or specialty CHCC for patients with 1 diagnosis or same needs Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:99, 4, 99, 109. Schmucker D, Group Medical Appointments. 2006:40; Scott et al. J Am Geriatrics Soc. 2004:1468. 12 Types of SMAs DIGMA • DIGMAs target 10-16 patients per session, with patients attending when they need care • A multidisciplinary team supports the DIGMA • DIGMA types: – Heterogeneous—each session open to most patients • Target census levels easiest to achieve – Homogeneous—grouped by disease or level of utilization – Mixed—physician practice divided into 4 large groups, 1 for each week of the month • Outcomes measures – Patient access – Physician productivity – Patient and physician satisfaction Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:xxx, 4, 31, 35-38. 13 Types of SMAs Physicals SMA • Focus is on physical exams, with 6-9 patients per session in primary care • Improves patient access to complete exams and increases patient education delivered • Provides private exams to patients followed by interactive group meeting • Can help work down backlog for physicals • Can be applied to specialty practices including: – Well-baby checkups in pediatrics – Foot exams in podiatry – Intakes and follow-ups for knee and hip replacement in orthopedics Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009: 4, 12, 125, 127, 129. 14 Types of SMAs Customize SMAs • SMAs need to be customized to the physicians who will be conducting them • Consider the following when designing the SMA: – The most pressing problem in the physician’s practice – How the SMA can help to solve the challenge – The patient segment the physician wants to target • Is there a large enough segment to fill the SMA on an ongoing basis? – The resources available to the physician to support an SMA Source: Schmucker D. Group Medical Appointments. 2006:117-118. 15 SMA’s Part 2 (Con’t) • Studies Showing How Effective SMA’s Can Be Source: Schmucker D. Group Medical Appointments. 2006:117-118. 16